Antibiotic resistance: rapid diagnosis and targeted treatments for the sustainability of the National Health Service

Antimicrobial resistance is one of the greatest threats to public health, but it also poses an economic sustainability challenge that our National Health Service cannot afford to underestimate. An infection that is difficult to treat often leads to longer hospital stays, more complications, greater use of resources and, in the most serious cases, an increased risk of death. Tackling this phenomenon is not just about developing new antibiotics. Above all, it means rethinking the way we diagnose and treat infections, moving beyond a view of healthcare spending that focuses solely on the cost of individual medicines.

The figures help to illustrate the scale of the problem. According to the AIFA Report for 2024, total expenditure on antibiotics in Italia reached approximately 1.5 billion euros. The consumption of systemic antibiotics fell by 3.3 per cent compared with the previous year, but significant issues remain regarding the appropriateness of prescribing. The ratio of broad-spectrum to narrow-spectrum antibiotic consumption stands at 12.3, compared with a European average of 4.6. This is a significant indicator: there continues to be heavy reliance on drugs that target a wide range of bacteria, even when a more selective treatment would be preferable.

Antibiotic resistance is also a cause for concern. Monitoring by the Italian National Institute of Health shows that in 2024, over a third of invasive isolates of Enterococcus faecium – a bacterium that can cause serious hospital-acquired infections – were resistant to vancomycin. This is not an abstract phenomenon: the consequences are felt most acutely by elderly patients, those who are immunocompromised, transplant recipients and those undergoing complex courses of treatment. The OECD has identified Italia as one of the European countries most exposed to the healthcare costs arising from drug-resistant infections.

For too long, we have viewed antibiotics primarily as an expense. An innovative medicine may have a higher purchase price than a traditional treatment, but this difference, on its own, says nothing about its actual cost-effectiveness. If an appropriate treatment, administered promptly to a patient who needs it, enables better control of a serious infection, reduces the duration of treatment or prevents complications, the benefit must be assessed by considering the entire course of care. Of course, this does not mean using the most expensive medicines indiscriminately: it means choosing the appropriate ones, when they are genuinely necessary, with the correct dosages and durations.

It is here that rapid microbiological diagnostics also take on economic and organisational significance. Certain methods now make it possible to identify microorganisms and specific resistance mechanisms within a few hours, providing information that, using traditional methods, might have taken much longer to obtain. But technology alone is not enough. Laboratory results must be swiftly translated into clinical decisions through constant collaboration between microbiologists, infectious disease specialists, intensive care specialists, surgeons and other specialists. Without this integration, we risk having innovative tools at our disposal without fully realising their benefits.